If you're over 40, you probably remember that first time someone called you "Ma'am" or "Sir." It almost surely hurt, no matter how young and fit you felt. Evidently, your age was showing in those wrinkles and sags.
Some decide to live with it; others do everything they can to obliterate the evidence. Today there are more nonsurgical options than ever to erase lines, thanks to new developments in the world of fillers.
Thirty years ago, a filler such as Zyplast (cow collagen) would be injected to bring a line or scar up to the level of the surrounding skin. But that ignored the other signs of aging, such as under-eye hollows and sunken cheeks, a softer jawline, narrower lips and a flatter bridge on the nose — all caused by shrinking bones, shrinking fat pads and thinning collagen (the substance in skin that makes it firm and plump).
"As we get older, we get laxity in the skin because we've lost the volume over which to drape it," says Dr. Ava Shamban, assistant clinical professor of
Enter the new generation of volumizing fillers that allow doctors to recontour the face more efficiently than ever before. For example, judicious use of a thin filler underneath a flattened brow bone will result in a brow lift. And injecting a thicker filler along a sunken cheekbone will not only round out the cheeks but lift up the nose-to-mouth lines too. Here are some of the newest tools in the effort to look younger.
Approved by the
Although the resulting liquid is not thick enough to use on hollow cheekbones, it excels at detail work such as plumping out smile lines, pucker lines, "marionette" lines, pitted acne scars and the thin, crepey skin under the eye. Shamban, one of the clinical investigators in the Laviv trials, says: "I use it for full-face rejuvenation — basically, anywhere a patient has a wrinkle. Because these fibroblasts, these little collagen-making machines, get to work and not only fill the lines but improve pores, pigmentation and overall skin texture. There seems to be a fresher look to the whole area where the skin was injected."
Laviv isn't a quick fix, since it takes six weeks from that snip behind your ear to the delivery of the vials of liquid. But the treatment lasts two or more years, a dramatic improvement over more temporary fillers (such as
Physicians qualified to inject Laviv are listed on http://www.mylaviv.com, but the local doctors who ran the safety and efficacy trials required by the FDA are Shamban (Santa Monica and Beverly Hills), Dr. John Joseph (Beverly Hills), Dr. Rhonda Rand (Beverly Hills), Dr. Nancy Silverberg (Newport Beach) and Dr. Stacy Smith (San Diego).
A synthetic form of a substance found in skin, a sugar that binds water to add volume, hyaluronic acids are already the most popular fillers on the market (think of brand names Restylane, Perlane, Juvederm). But a new entrant, Belotero, is said to have advantages over the others because it can be injected in the very thin skin under the eyes or near the mouth without causing a bluish hue (a small risk with the others), and it may have slightly more longevity. This filler has been approved by the FDA and will be more widely available in December or sooner if a marketing injunction filed by a competitor is lifted. If your doctor already offers Belotero, he or she is one of the lucky "old customers" who are unaffected by the injunction, which applies only to new customers
On the cusp of FDA approval is Voluma, the first hyaluronic acid that, due to its large particle size, can add real volume to the cheeks, cheekbones and chin. "That's going to be very exciting," says Shamban, adding that it's been used safely in Europe and Australia. And there's news about good old Restylane. Although it's been on the market for years, it recently received the FDA's blessing to be used for lip revolumization. "That's the only hyaluronic acid with a label for the lips," Shamban says.
All this competition among drug companies is turning into good news for the consumer. Watch for rebates or specials from
But Chipps says job one for the consumer "is to choose a physician who's trained and experienced in using fillers, and that's most commonly a board-certified dermatologist or a facial plastic surgeon." Find one at Aad.org or Plasticsurgery.org.